Will 5010 Transactions Standards, E-prescribing Cost You Money?

June 30 Deadlines Loom Big for Some Family Physicians

June 18, 2012 05:25 pm News Staff

Draw a big red circle around June 30 on the calendar because that date marks two important deadlines that, if missed, could have adverse financial implications for family physicians.

First, physicians need to be aware that the enforcement discretion period for use of the updated 5010 transactions standards ends on June 30. As mandated by the Health Insurance Portability and Accountability Act (HIPAA), the 5010 version replaces the 4010/4010A standards.

All physicians who transmit and receive electronic health care transactions must do so using the new 5010 standards. Physicians not fully compliant with the version 5010 standards after June 30 are subject to enforcement action under the existing HIPAA transaction and code set enforcement process.

Simply stated, physicians not in compliance could suffer serious cash flow consequences when their Medicare claims are rejected.

story highlights

  • Two deadlines with financial implications for family physicians are fast approaching.
  • On June 30, the enforcement discretion period for use of the updated 5010 transactions standards ends and noncompliant claims will be rejected.
  • Physicians who want to avoid a 1.5 percent penalty on their 2013 Medicare payments must by June 30 have either applied for an e-prescribing hardship waiver or sent a minimum of 10 prescriptions electronically during the first six months of 2012.

According to a CMS statement(www.cms.gov) released in March, the designated enforcement agency is CMS' Office of E-Health Standards and Services. In March, that office predicted a 98-percent compliance rate with the 5010 standards by June 30.

The other deadline closing in on physicians concerns the second electronic prescribing penalty, which is set to hit noncompliant physicians in 2013. Physicians who did not e-prescribe in 2011 already receive 1 percent less in their Medicare paycheck in 2012.

To avoid receiving the 2013 penalty -- which would be a 1.5 percent decrease in Medicare payment -- by June 30, physicians can either request a hardship exemption(www.qualitynet.org) or report the "G" 8553 code signifying that they sent prescriptions electronically for at least 10 billable Medicare Part B services provided between Jan. 1 and June 30, 2012.

A past issue of CMS' MLN Matters(www.cms.gov) publication provides detailed information about the 2012 Electronic Prescribing Incentive Program, including the timeline for payment adjustments that will be applied to noncompliant physicians.

Physicians with questions about the electronic prescribing program can contact CMS' QualityNet Help Desk at (866) 288-8912 or send questions by e-mail. Help desk hours are Monday through Friday 7 a.m. to 7 p.m. CDT.

Although the Academy's Center for Health IT does not recommend or endorse health information technology companies or their products, Jason Mitchell, the center's assistant director, said physicians who haven't yet started e-prescribing -- and who need to send the required 10 electronic prescriptions ahead of the looming deadline -- could check out free solutions offered by the National e-Prescribing Patient Safety Initiative(www.nationalerx.com), Practice Fusion(www.practicefusion.com) and ScriptPad(scriptpad.net).

Mitchell advised physicians who slip in under the deadline to follow up soon after with work to implement full-time e-prescribing in their practices.